Vuelo y llegada

Before we left, Allie and I predicted three cruxes on our trip down. First, we had to make it through the flight without Allie having  major panic attack. Second, once at the airport in Guatemala City we had to successfully find our ride to Santiago. Third, we had to actually make it to Santiago.

Regarding the first crux, Allie did not have a major panic attack on the plane. Good. But this was an eventful flight for another reason. About 30 minutes into the flight we hear over the intercom, "Is there a doctor on the plane?" Well, technically yes, since Allie is a doctor (veterinarian) and sort of yes since I'm a med student. So we pushed our call button as instructed and were called back to the back of the plane. There we found a 20 something lady with her husband. She is lying in his arms on oxygen recovering from having lost consciousness briefly. He says she's having a panic attack, and sure enough when the plane hits another bumpy patch her eyes get huge and she starts hyperventilating and then passes out again. After talking with her and her husband, making sure she was alert and coherent, checking her vitals, and assessing what the plane had to offer in terms of medical equipment, we decided it was ok to continue and that she'd be fine. She has a history of significant panic attacks like this (but she said no one has ever believed her), and she was incredibly appreciative of some simple comforting and reassurance. I have to say, it was a new and somewhat unnerving feeling to have the whole staff asking whether we needed to turn the plane around and looking at me for the answer. I guess I could have made that call if the situation was different and more serious, but that would be pretty tough, to turn a whole plane around!

Regarding the second crux, Juan was right there and it was as easy as it could be to get from airplane to van. This can't really be considered a crux in retrospect. Good on ya, Juan!

Regarding the third crux, which was in our estimate the real crux of this process due to the recent tropical storm rains and huge potential for mudslides and consequent road closures, we accomplished it thanks to some great driving by Juan. He took us down a longer road to Santiago to avoid the potential mudslides on the usual more direct road. But the road we took was not without damage. During the rains, a large bridge over a medium sized river collapsed, but that road was still our best option. Juan did some quality off-roading and we forded the river successfully! Otherwise everything was fine. Crux accomplished.

Santiago is a cool place. In my estimation, it's a pretty typical small/medium sized latin american community. The streets are all stone, and pretty narrow. The cars and trucks zig zag past copious pedestrians, and the tuk-tuks (little scooter taxis) dart around everything. The buildings are mostly one story, occasionally two or three, painted in every color you can think of, and are all made from "block," which is cinderblock. The roofs are tin. They are all contiguous, as is the case nearly every latin american town I've been to, which gives the streets the feel of a corridor with no ceiling. Santiago is not a "tourist town" by any stretch of the imagination, but there are enough tourists to support a "gringo street."


Peyton met us yesterday evening and after he spoke to several of his friends who work here at Posada we walked to town. It's about 10 minutes from Posada to the center of Santiago, so quite close. We walked down gringo street with the primary goal of finding Allie a new pocketbook since hers broke on the plane. After some quality bartering by Peyton, we got a great one that Allie loves. We kept walking and ended up at the docks where you can catch lanchas (small ferry boats) to the other towns on the lake. By then we were beyond famished; Allie and I had breakfast early before our flight out of Raleigh, but since that time had only eaten some peanuts. Dinner at Posada was incredible. Best beef I've had in a long time. The owner is a chef - that is, an officially trained legit chef - and the food is GOOD. Normally I like to eat at the local places when I'm in a foreign town, but we might have to make an exception this time, the food is just too good.


This morning, Allie and I went canoeing for a few hours on lake Atitlan. Santiago sits along the shore of a bay of lake Atitlan, so we weren't out in the middle of the big area of the lake, but still it's pretty wide open. It was good exercise and we just finished a well earned lunch. Life is good.


Tomorrow the plan is to go horseback riding with this couple down the way. We've heard good things, and we're looking forward to it.


I'm really looking forward to getting to work at the clinic in Santa Cruz. I'll start on Monday after Allie leaves. Peyton has been filling me in on the goings on, and it sounds like a really wonderful experience. This should be a great month.


Here are a few pictures from around the Posada this morning.

Pensamientos

This is the start of my last year in medical school. Wow. Just a few days ago I was trying to figure out where MBRB was, right? (That's where our classes are held at UNC.) I was talking with a friend and classmate recently and we decided that looking back on the last three years of medical school is like seeing through bi-focals. Depending on the moment, it can seem like no time has passed at all and somehow you just appeared here at the start of 4th year with some knowledge and skills you can't even remember learning. Or at other times it can seem like those earlier years are a far distant memory, so much living and doing and experiencing having transpired within them. No matter which way you look at it, it impresses you and makes you pause and reflect. 

What really gives me pause is this: I remember realizing at the beginning that I didn't see how I'd ever get to where I am now, just one year from graduation. I guess I knew I would one day, but it didn't seem tangible and real. Now that I'm here, I know of course that it is real. What's cool is that the retrospective feeling is like the mirror image of a prospective one about the future, the former almost forcing the latter on you, making the experience going forward so much richer. 

What does that mean? It's hard to capture the feeling, but I know it when I feel it. There's another situation where I feel the exact same feeling. Hiking up a foot trail in the mountains, climbing for miles, sweat pouring, your eyes fixed on the rocks, roots, soil, plants in front of you, listening to the sound of your breath, focused internally on keeping your body moving. You reach a switchback, a place where the trail makes an abrupt 180 degree turn in order to keep making upward progress. You've encountered switchbacks before, hundreds of them, but this one has a clearing just beyond it, a rock that juts out beyond the trees. You take a brief moment and step out. For the first time in a long while you remove your pack, take a deep breath and look at the view. It's been there the whole time, but you were focused and didn't see - and for good reason, the going is tough. But now you see. You see the mountains, the forests, the animals, the sun and blue sky. And you think for a minute and start to piece together what you're seeing. That ridge - we just came up that ridge an hour ago. And just beyond it, the peak right there, that was the crazy climb that nearly whipped me. And if you look really carefully and the sky is particularly clear you can see all the way back to where you started. It's so far away. How did we come this far? And how did we get here so fast? A joy wells up and you think to yourself, "I'm doing it; I'm actually doing it!" Then you look ahead and see way off in the distance a peak that marks your destination. Were this the start, and were you just now gauging the effort to come, you might balk at the idea of it. But now on this rocky clearing, with the beginning and end both in view, you see how far you've come and it impresses you. You remember how it felt to be at the beginning with so much to come. And when you consider the distance, the sweat, the climbing that remains, you feel the difficulty just as you did at the beginning, but your view is changed. There is a sense that it passes, that the end does come, and you've felt the joy that comes with progress. Your recent accomplishment laid out before you, you can imagine yourself at your destination, looking back over the ascent with same feelings you're having now. And this dual view - looking back over your progress and forward over what lies ahead - gives you the freedom to enjoy the road to come. Yes, there will be stretches where your eyes are fixed on your own footsteps and you block out the world around you. But always you can smile, anticipating the joy that comes, relaxing a little because you're confident it will come.

Antes

In two days my wife and I leave for Guatemala. I'll be there for a little over a month; she's headed back after five days. Our first destination is Santiago on Lake Atitlan, our base for the vacation portion of the trip. We don't have specific plans, but some town wandering, swimming, kayaking, and eating are certainly on the agenda. After this brief summer vacation between 3rd and 4th year, I start at Mayan Medical Aid in Santa Cruz, also on Lake Atitlan. I'll be there for four weeks seeing patients in the clinic in Santa Cruz and other smaller satellite clinics, as well as studying Spanish.


Some of my thoughts going into this month:

I anticipate learning a ton of Spanish. This last year has been wonderful in terms of opportunities to speak Spanish in the hospital. Raleigh and the surrounding areas of NC have a pretty good Spanish population; and Wake Med, where I've done the majority of my 3rd year, serves a large Spanish speaking population. It's been fun taking care of Spanish speaking patients; almost all of whom have been incredibly grateful to have someone who speaks their language involved in their care. I wonder how the dynamic will change when the patients' language is no longer in the minority? Will the surprised smile I see after greeting a patient in Spanish be replaced by a frown of misfortune at having scored the US medical student? I doubt it, but it certainly will be interesting to see what sort of differences there are delivering care to similar populations in very different settings.

Is this something I can do more of in the future? My wife and I would like to make international medicine, in some way or other, a part of our lives. But neither of us has done any yet. I'm hoping this month is the start of something we can share together.

It's been several years since I was away from my wife for a month. In fact, that last time was before we were married. It's not going to be easy, but I think overall the experience will be a good one. At least the dogs will be at home to keep her company.


My goal for this blog is to be pretty free-form with it. I don't have a set plan, no set of questions I aim to answer, no particular theme I'll try to pursue. Rather, I'll share pictures as often as I can and I'll write as often as I can - about life on Lake Atitlan, the practice, the people, the fun, and whatever else comes to mind. If you're curious about something, just post a message after one of my posts and ask.


And now for packing, of which I have done zero.